Kratom has caused widespread controversy in recent years among the U.S. Food and Drug Administration (FDA) and advocacy groups. The FDA is set on classifying the substance — which is largely unregulated — as a schedule 1 opiate. Yet advocacy groups claim it has many medicinal benefits, including helping people withdraw from more powerful opioids, such as heroin, with few side effects.

What Is Kratom?

Kratom, otherwise known as Mitragyna speciosa, is a tropical tree originating in Southeast Asia and some parts of Africa. It has been used for centuries both medicinally and recreationally. Kratom’s leaves contain the psychoactive opioid compounds mitragynine and 7-hydroxymitragynine.

Kratom is available in various strains, colors, formulations and doses. In small amounts, it can produce mild mood-uplifting effects and relieve anxiety, or be used as an aphrodisiac. In larger amounts, kratom has the same effects as opioids, providing pain relief and a sense of well-being and relaxation. Some use kratom to assist the withdrawal symptoms and cravings caused by opioids.

It is commonly referred to as herbal speedball, biak-biak, ketum, thom, kahuam, and ithang. Some strains are named Bali Maeng Da, Red Vein Thai, Red Vein Kali, Green Vein Kali, White Vein Kali, White Vein Thai, Super Indo, Ultra Enhanced Maeng Da, Super Green Malaysian and Full Spectrum Tincture.

How Is It Used?

The plant is usually crushed or mixed with water, but it can also be taken in capsule form. Historically, farmers chewed the leaves of the plant to provide energy while working in fields, although it is now banned in parts of Southeast Asia.

How Does It Affect The Brain?

According to the National Institute on Drug Abuse, kratom contains two compounds, mitragynine, and 7-hydroxymitragynine, that interact with opioid receptors in the brain and produce sedation, pleasure, and decreased pain — especially in large doses. Mitragynine may also interact with other receptor systems in the brain to produce stimulant effects. When kratom is taken in small amounts, users report increased energy, sociability, and alertness instead of sedation.

The National Institute on Drug Abuse (NIDA) warns that kratom can sometimes have dangerous side effects including insomnia, vomiting and nausea, seizure, liver damage, itching, sweating, dry mouth, constipation, increased urination, sensitivity to sunburn, and even psychosis.

According to the FDA, there are deadly risks associated with kratom use. However, NIDA states that while kratom has been detected in the bodies of those who died of a drug-related overdose, the deaths were caused by other drugs laced with powerful compounds.

Is Kratom Addictive?

Some users claim the drug is not addictive. But according to NIDA, kratom may cause dependence, leading to withdrawal symptoms when users stop taking the drug. Those symptoms include:

  • muscle aches
  • insomnia
  • jerky movements
  • emotional changes
  • irritability
  • runny nose
  • aggression

Is Kratom Legal?

Kratom is not currently an illegal substance, but some states have banned it, including Alabama, Arkansas, Indiana, Rhode Island, Wisconsin, Vermont, Tennessee, Washington D.C., and parts of Illinois. Legislation is being introduced to restrict or ban kratom in California, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, New Hampshire, New Jersey, New York, and Oregon.

How Are The FDA And The DEA Treating Kratom?

In 2012, the FDA introduced an import alert on kratom. However, as it is a botanical supplement, the FDA cannot restrict its sale unless they are able to prove it is dangerous or marketed for medical purposes. Despite this, the agency labeled it as a suspicious substance in 2014, banning its import into the U.S. and seizing several thousand pounds worth.

On August 31, 2016, the DEA announced a temporary federal ban on kratom’s active materials under the Controlled Substances Act. However, on October 12, 2016, following public outcry, it withdrew this policy, stating that it needed to obtain further research.

Kratom linked to opioid properties

Most recently, the FDA issued a statement in February 2018 saying that it had determined that kratom has “opioid properties” and has been associated with 44 deaths between 2011 and 2017. FDA Commissioner Scott Gottlieb said that the agency’s computer system used to analyze drugs conclusively showed kratom is an opioid, stating “potential for abuse, addiction and serious health consequences, including death.” Gottlieb wants kratom banned and classified as a schedule 1 drug under the Controlled Substances Act (CSA).

Kratom Controversy In The News

In 2016, a bipartisan group of 62 U.S. House and Senate members spoke out against the ban, resulting in the Pocan-Salmons letter to the DEA urging acting administrator Charles Rosenberg to delay scheduling and highlighting the need to “engage consumers, researchers, and other stakeholders, in keeping with well-established protocol for such matters.” They warned that “a departure from such guidelines threatens the transparency of the scheduling process and its responsiveness to the input of both citizens and the scientific community.”

Gottlieb’s latest statement in February 2018 caused a backlash from some members of the scientific community as well as kratom advocacy groups. Nine scientists who specialize in substance addiction sent a letter to current DEA Administrator Robert Patterson and the head of the White House opioid crisis team, Kellyanne Conway. The letter disagreed with FDA analysis, saying that “a body of credible research on the actual effects of kratom demonstrates that it is not dangerously addictive, nor is it similar to ‘narcotics like opioids’ with respect to ‘addiction’ and ‘death’ as stated by the FDA.”

While kratom impacts the opioid receptors in the brain, the drug is distinct from classical opioids like morphine, heroin, and oxycodone both in terms of how it is made and its effects on the body, according to the scientists’ report. Additionally, kratom is derived from a tree that is part of the coffee family, not the opium poppy family. Kratom does not appear to produce the highly addictive euphoria or lethal respiratory-depressing effects of classical opioids.

The scientists said that making a recommendation based on associated deaths rather than deaths actually caused by kratom is not a scientifically valid reason for placing the drug on a controlled substance schedule. They encouraged the White House to ensure continued lawful access to kratom, guide balanced regulation of the drug, and facilitate more research.

The American Kratom Association (AKA), a nonprofit organization that advocates for the beneficial use of kratom, estimates that 3 to 5 million Americans use kratom beneficially. AKA Chairman David Herman challenged the FDA claim that kratom can be associated with deaths and demanded that the agency stops its disinformation campaign against kratom. Herman said the FDA’s “war on kratom” is a hoax based on a computer model that generates false data.

Many scientists, including former NIDA addiction expert Jack Henningfield, claim that the FDA’s Gottlieb is misinformed and has no real-world or laboratory evidence to back up his assertions about the dangers of kratom. Henningfield sees the potential for kratom to help overcome opioid addiction and fears that banning it may cause a black market supply, with zero regulation, overnight.

The current situation is that the DEA lists kratom as a “drug of concern.” The FDA has presented its analysis to the DEA and is awaiting that agency’s scheduling decision while it continues to review the literature and research about kratom.

 

 


Sources

NIDA. (2016). What is kratom? https://www.drugabuse.gov/publications/drugfacts/kratom

Taylor, D. (2016). Washington Post: What is kratom and is it dangerous? https://www.washingtonpost.com/video/national/health-science/what-is-kratom-and-is-it-dangerous/2016/10/12/7f651976-7c4f-11e6-8064-c1ddc8a724bb_video.html?utm_term=.e974879ae164

FDA. (2017). Statement from FDA Commissioner Scott Gottlieb, MD, on FDA advisory about deadly risks associated with kratom.

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584970.htm

Killelea, E. (2018). Rolling Stone Magazine: Kratom: Why did the FDA declare the herbal supplement an opiate?

https://www.rollingstone.com/kratom-why-fda-declare-herbal-supplement-opiate-w517359

Botanical Education Alliance. (2016). Pocan Salmon Letter: Prevent Drug Enforcement Agency Overreach and Preserve Consumer Access to Natural Herbal Supplement Kratom.

https://www.botanical-education.org/wp-content/uploads/2016/09/325084831-Dear-Colleague-for-Kratom-Letters-to-Outside-Organizations2.pdf

American Kratom Association. (2018). Letter to Kellyanne Conway and Robert Patterson.

https://docs.wixstatic.com/ugd/9ba5da_bc5de76f73b5432dab140ed69a67e596.pdf

American Kratom Association. (2017). Press releases. AKA Demands FDA Stop its Disinformation Campaign Against Kratom.

https://www.americankratom.org/press-releases
Kratom Science. (n.d.). Kratom Strains, Effects and Dosage.

Wing, N. (2017). Huffington Post: Feds Prepare For A New War on Kratom, An Herbal Drug Many Swear By.

https://www.huffingtonpost.com/entry/fda-kratom-regulation_us_5a0b465be4b00a6eece4c9e0